Missing the point (again)

This is the text of an article in Public Servant magazine. I would like to have written something more substantial, but the word limit (which was perfectly reasonable) was limited. As it were.

Paying excessive attention to 'efficiency' and function militates against good overall care. The values that are supposed to ensure people are well-treated get subsumed.

We live in an age of fundamental suspicion. One could argue that fifty years ago the default position of most citizens was to trust unless given evidence that trust should be withheld; now the default is to suspect everyone, trust no one and deny everyone’s integrity.

Perhaps it is no surprise, then, that this is reflected in the culture developed in our public institutions. Couple this with a media that hears a politician sneeze and accuses him of deliberately trying to infect the vulnerable, and you have got a vicious circle of suspicion.

But, if that isn't enough, we then create a culture of competitiveness and 'efficiency' that uncritically assumes that the only measurement of 'the good' is financial. Hence, the NHS, for example, bounces from centralisation to localisation and back, education abandons local accountability and cedes power to the Secretary of State in Westminster (whilst thinking it is gaining greater autonomy – but see what happens if an academy struggles or the said Minister changes his fancy), and vast sums of money are spent in ideologically-driven yo-yo re-engineering.

If only there was a basic understanding of the difference between 'efficiency' and 'effectiveness', we might be in a better place.

In other words, we now have a deep cultural problem across our society – a functionalism that compromises public service. The cultural associations run deep and to question them is not easy to do – not least because they quickly assume the status of 'orthodoxy', from which heretics find themselves dismissed with ridicule.

Changing this situation cannot be easy and, by definition, solutions will necessarily be long-term and complex. It is possible that some of our systems might have to collapse before the construction of something more coherent and effective becomes possible.

For example, is it any surprise that health visitors find themselves hot-desking in an attempt to reduce rental costs for offices, but then lose the very context that allows for ready exchange of information, informal mutual encouragement or advice, joined-up consultation on particular cases or issues? The 'human' stuff always finds less value than what can appear on a balance sheet.

And, of course, this sort of thinking derives from a confusion of ends and means. If the end is to reduce costs (finance-driven), then the exercise becomes merely functional. If, however, the end is to enhance service to real people – to which end finance is a means – then different values might apply and priorities be set. This is not to deny the need for financial probity and wisdom, but it is to ask what the end is to which the finance becomes the means of getting there.

Somehow this situation requires a rejection of the sort of box-ticking mentality that leads to hospitals losing the plot. If the Francis report exposes anything, it is that paying obsessive attention to the engineering (form filling, box ticking, time accounting) militates against good overall care because the means become the end. The people get lost. The values that are supposed to ensure that people are well treated as dignified human beings get subsumed – not deliberately, but at the level of assumption in the complex dynamics of making sense out of chaos) – into something different. And when this happens bad practice becomes inevitable.

Naturally, recovering a culture of trust, integrity and clarity about what constitute ends and means is no easy task. It requires the political will to change the vocabulary of public rhetoric. It demands an open and constructive public debate about what is the end to which we aspire and for which the money we pay is intended to be a means. And this will need a re-articulation of what might untrendily be called 'anthropology': how to enable people to flourish.

Share this:

Like this:

Related

10 Responses to “Missing the point (again)”

very well said. I took early retirement from the probation service because they attempted to “fix” what wasn’t broken, and in the process exchanged much of what was effective for the false god of efficiency. We have more in common than a car!

Any Archbishop with a history of confronting death at the hands of wronged Nigerian delta-dwellers, of smuggling bibles in Romania and the record of being that rare beast, a rat joining a sinking ship, has got to have a vast cedit of credential capital ! Hopefully he won’t baulk at confronting the incompetence of church bureaucracy or of representing the church’s truer convictions in the House of Lords.

We live in an age of fundamental suspicion. One could argue that fifty years ago the default position of most citizens was to trust unless given evidence that trust should be withheld; now the default is to suspect everyone, trust no one and deny everyone’s integrity.

And the Church plays by these rules too.

And if the report published by the Diocese of Winchester is correct (see here for context and link) it is right to do so.

The church is all too easily prey to the same pressures. How many “pastoral” reorganisation schemes have in reality been born as “financial stability schemes” when Boards of Finance quite rightly respond to budget imperatives. In public service and the church the need for brilliant leadership has never been more acute. (No pressure Bish)

Excellent post. I am an NHS health professional working alongside children and their families. This week I received a very moving letter from the mother of a child who had recently passed away due to a progressive condition, thanking me for what I had done. In it she alluded to my expertise but the main focus of her letter was the level of friendship and support I had given the family during this very difficult time. It made me realise (again) that it is who we are that is so important, not just what we do. This unseen dynamic is vital and cannot be plotted on a graph of fulfilled outcomes, or list of tick boxes. There is a danger of losing that in this culture of “efficiency”. Let’s not lose our humanity in the process.

Having spent a night in hospital last week my comment on “release” was “I can’t fault the treatment but the care is abysmal.” Lack of care included not being told what was happening during a wait of 6 hours to see a doctor on a “Surgical Assessment” ward and being left by a nurse with my backside exposed to any “viewers!”

Ticking boxes simply divorces people from their true purpose – I am reminded of the, probably apochryphal, story of the stonemason on the site of Liverpool Cathedral who, on being asked by a visitor what he was doing, replied “I’m building a cathedral.” The box-ticker would have responded ” I’m chipping some stone!”